Basic Health contracts with health plans all over Washington State to provide reduced-cost health care coverage to qualified Washington State residents.
- Monthly premiums are based on age, income, family size, and health plan chosen
- No copayments for preventive care services
- Low copayments on some services
- $250 annual deductible
- 20% coinsurance on some services
- $1,500 annual out-of-pocket maximum
Choice of Provider
- Select your own doctor or other provider affiliated with the health plan you choose
- Choice of health plans in most counties
- Decide on the health plan that offers the best value, location, and providers for you
- Doctor and hospital care, including preventive care
- Emergency services
- Prescription drugs
All health plans in Basic Health offer the same basic benefits, but monthly premiums, providers, and some details of coverage vary (such as which prescription drugs or preventive services are covered). Your monthly premium depends on:
- The program you choose,
- Your age,
- Your income,
- The number of people in your family,
- The health plan you choose, and
- Where you reside.
See Health Plan and Premiums for more information about monthly premiums. Call 1-800-660-9840 if you need help with your estimate.
How it All Works
To be eligible for BH, you must:
- Be a Washington resident;
- Be a US Citizen or qualified non-citizen;
- Be between 19-64 years old;
- Have gross family income at or below 200% of the Federal Income Guidelines;
- Have countable income for your family between 0-133% of the Federal Income Guidelines;
- Not be eligible for Medicaid or be receiving DSHS medical care services;
- Not be eligible for free or purchased Medicare;
- Not be a full-time student who has received a temporary visa to study in the United States;
- Not be institutionalized at the time of enrollment; and
- Not be enrolled in the Washington Health Program
Your Monthly Premium
Once enrolled in Basic Health, you'll get a bill for your monthly premium about six weeks before the month covered by that payment. (For example, the bill for December coverage is sent in mid-October; payment is due November 5.) Your monthly premium payment must always be received by the fifth of the month prior to the coverage month. If you do not pay your premiums when due, you will lose your coverage for at least one month, so it is important that you pay each monthly premium on time. Partial payment or checks that cannot be processed for any reason (for example, checks returned for non-sufficient funds or no signature) will be considered nonpayment.
If you are covered through a home care agency or financial sponsor will be paying all or part of your monthly premium, Basic Health will bill them directly. You may be required to contribute toward your monthly premium through them. Contact your group representative for more information.
Each Basic Health member is responsible for sharing the cost for his or her health care coverage. Cost sharing comes in the form of copays, coinsurance, and deductibles. In addition, each member will have an out-of-pocket maximum. (See Definitions and examples.)
If a Basic Health member changes health plans any time during the year, the amount paid toward the deductible and out-of-pocket maximum for covered family members will start over with the new health plan.
These cost-sharing responsibilities do not affect coverage for Basic Health Plus or the Maternity Benefits Program.
How the health plans work
The health plans require each Basic Health member to select a primary care provider (PCP). To receive benefits, you must receive care from your health plan's authorized providers. Your PCP may provide or coordinate your care. Each covered family member may have a different PCP. If you don't choose a PCP, your health plan may choose one for you. You may change your PCP during the year. Contact the health plan for more information on changing a PCP or for a current list of providers.
In an emergency, you may receive Basic Health benefits for care without prior PCP approval. However, you must report this to your primary care provider or health plan within 24 hours or as soon as possible. In addition, women may self-refer to a plan-designated women's health care professional for medically necessary services or medically appropriate follow-up for maternity care, routine gynecological exams, and reproductive care. Check with your health plan for details.
Any care not approved by your health plan is not covered under Basic Health. If you receive care that is not covered under Basic Health, you must pay the entire cost for those services.
Once you are enrolled in Basic Health, you need to let Basic Health know when you have any changes in family status or income. These changes may affect your monthly premium. If you do not keep income current, the state may require you to repay the state-paid portion of your premium.